Search

Aim: Colon ischaemia (CI) is most commonly an acute and reversible manifestation of a transient, non‐occlusive decrease of blood flow in the colonic microvasculature. Irreversible complications are uncommon and the progression to chronic CI remains controversial. Our objective was to identify cases of chronic CI and assess for distinct clinicopathological features. Method: A retrospective review was performed of CI patients having symptom chronicity of ≥ 1 month and ischaemic histology at our institution from 1994 to 2015. Demographic, clinical, endoscopic, radiological, pathological and outcome variables were abstracted. Histological evaluation was performed by two gastrointestinal pathologists. Results: Fifteen patients (n = 9; 67% men) with a median age of 65 years (range 22–88) were identified. The most common presenting symptoms were diarrhoea and abdominal pain (n = 6, 86%; n = 5, 71%, respectively). The typical endoscopic appearance was segmental ulceration of the sigmoid colon (n = 6, 75%). Vascular imaging showed patent mesenteric vessels in all patients. Histopathological evaluation revealed venous intimal hyperplasia consistent with idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) in eight patients; the remainder showed non‐specific ulceration and fibrosis. Surgical resection was performed in seven IMHMV patients, resulting in symptom resolution. On re‐review of pre‐resection biopsies, all IMHMV patients had characteristic changes of hyperplastic, thick‐walled, hyalinized vessels in the lamina propria. Conclusions: IMHMV is a unique histopathological entity causing chronic CI. The small vessel histological changes in IMHMV are distinctive in colonic resections and undetectable by routine vascular imaging. Preoperative diagnosis of IMHMV is possible with endoscopic biopsy and segmental colon resection is curative. [ABSTRACT FROM AUTHOR]

Secondary achalasia may result from diseases that either infiltrate or compress the lower esophageal sphincter to create an increased high-pressure zone and subsequent esophageal body changes. With bariatric surgery, a potential high-pressure zone is created by a sleeve, band, or bypass just distal to the esophagus. We report four patients who years after a bariatric procedure developed dysphagia followed by esophageal body radiographic and/or manometric features of achalasia. In addition, each of these patients responded symptomatically to endoscopic or surgical therapy either which lowered this high-pressure zone. Furthermore, review of prior cases in the literature suggests this has occurred before. Physicians should be aware of this association but further study is needed on its true prevalence. [ABSTRACT FROM AUTHOR]

The article presents case study of a 60-year-old woman for enteral nutrition, with history of chronic diarrhea, vomiting and weight loss.

The article presents the case study of a 82 year old woman with abdominal pain and weight loss. It is noted that she had an epigastric mass with the diagnosis being neutrophilic leukocytosis. The article discusses the problems posed in the diagnosis of mucinous neoplasms (MCNs) from Intraductal papillary mucinous neoplasm (IPMN).

The article presents a case history of a patient presented with diarrhea, abdominal pain, and muscle cramping upon performing abdominal computed tomography scan it was diagnosed that patient suffers from Zollinger-Ellison syndrome.

The article presents a case study involving a novel technique for placement of overlapping self-expandable metal stents (SEMS) in a 67-year-old patient with pancreatic necrosis. Gastroduodenal SEMS are used to close fistulas after gastric surgery and to close iatrogenic duodenal perforations. The case illustrates an innovative approach for SEMS deployment through a gastrostomy site for the treatment of a massive pancreatitis-induced duodenal fistula.